Provider Demographics
NPI:1275727224
Name:CAROLINA PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:CAROLINA PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:CHAPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-739-6628
Mailing Address - Street 1:421 HULON LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4832
Mailing Address - Country:US
Mailing Address - Phone:803-739-6628
Mailing Address - Fax:803-739-5766
Practice Address - Street 1:421 HULON LN
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4832
Practice Address - Country:US
Practice Address - Phone:803-739-6628
Practice Address - Fax:803-739-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14490208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCN1741OtherRAILROAD MEDICARE
SC4646343OtherAETNA
SCGP1633Medicaid
SCGP1633Medicaid
SCCN1741OtherRAILROAD MEDICARE